Do B- Work

October 25, 2017

Yes, you read that right! I’m telling you to SLACK OFF

Your perfectionism has taken you far. It’s gotten you through medical school, propelled you through residency, and helped you find a great job. It’s the force behind the clear, concise, grammatically correct and error-free documentation you enter into your EMR every day — bright, shiny notes with your crisp e-signature at the bottom of which you are very proud.

And now it’s time to thank Perfectionism for its service and say goodbye.

Because there are a ton of undone tasks in your inbasket right now, cluttering up your computer screen and your mind. You’re being asked to accomplish way more in a given day than is possible. The more you dedicate time and energy to small details that don’t matter much to you in the scheme of things, the more burned out you will feel.

Here’s the secret: Burnout is not about working hard. When you work really hard for hours at something and you love the result, or you get into a flow and time is flying by at warp speed, you don’t usually feel burned out. Tired? Sure. In need of a break? You bet. But not burned out. The deadened feeling that comes with burnout goes hand in hand with other negative emotions like powerlessness, emptiness and anger, which in turn stem from doing things over and over that we don’t want to do or don’t see the value in.

It’s easy to get preoccupied with following rules to the letter and not wanting to “get in trouble,” or with wanting to manage other people’s perceptions of you (who doesn’t want to be seen as brilliant, insightful and clinically astute?). You may also be reluctant to cut corners because of beliefs you’re holding onto about what will happen as a result. Example: “I can’t do concurrent documentation because I don’t want to disrupt my relationship with my patients.” Or “I have to write a thorough summary for every patient in case someone else sees the writeup.”

There’s nothing wrong with those beliefs. They’re fine. But they’re locking you into an impossible workflow. You’ll never get everything done if you try to do everything being asked of you in every single instance. Meanwhile, you’ve got dozens of undone tasks, which isn’t good either! So that’s why it’s vital to figure out what B- work looks like as compared to A+ work, and then make a conscious decision to go with B- work at least some of the time.

B- is acceptable. It would not lose you your license. It covers the bases in a cursory way. It’s FINE. But it’s not worthy of being featured in the Model Charting Handbook. It might have a grammar error because you didn’t read it 10x to proofread. It’s shorter than you might like. Someone could definitely go through and tell you a bunch of things you should have added or clicked. But it captures the essence of the service you provided and the boxes necessary to sign off on the note have been checked.

A+ is for special circumstances. The especially complex case, the patient you’re most worried about. The case where you know there’s five other specialists who will be seeing the notes. Go for it. Write the heck out of it.

This idea can be applied to other things in your life besides notes, of course. Going with the Wegmans cake instead of the Pinterest cake. Sending an e-mail instead of a card. Giving a gift card instead of hunting down a thoughtful present.

If you’re a recovering perfectionist, keep these questions in mind:

🤔 What thoughts and feelings come up for you when you try to let something be good enough? — for a lot of people it triggers a defensive backlash of justification/rationalization for needing to do more and work harder, feelings of guilt and unworthiness, etc.

⚡ Where do you want to direct your energy? (It’s a finite resource!) — think, “being kind and empathic with my patients,” or “keeping my composure when getting the kids out the door in the morning.” Pick a couple of goals that align with your values and make these the focus. Shortcut the rest for a week and see what happens.

📝 What’s my version of B-? What does B- look like not only for my notes but for my parenting, my fitness, my marriage? The point here is not to strive for B- all the time in all areas, but in some areas some of the time — so that you’re freed up to do A+ work where it matters the absolute most to you.